Support for breastfeeding mothers: a systematic review

Abstract

Although the benefits of breastfeeding are widely accepted, the effectiveness of different strategies to promote the continuation of breastfeeding once initiated are less clear. The objective of this systematic review was to describe studies comparing standard care with the provision of extra breastfeeding support and to measure its effectiveness. Outcome measures used were rates of cessation of any breastfeeding or exclusive breastfeeding at chosen points in time. Measures of child morbidity and maternal satisfaction were also used when these were reported. Twenty eligible randomised or quasi-randomised controlled trials were identified, involving 23 712 mother-infant pairs. Extra support had a beneficial effect on the duration of any breastfeeding (RR [95% confidence intervals] for stopping any breastfeeding before the last study assessment up to 6 months 0.88 [0.81, 0.95]; 15 trials, 21 910 women). The effect was greater for exclusive breastfeeding (RR for stopping exclusive breastfeeding before the last study assessment 0.78 [0.69, 0.89]; 11 trials, 20 788 women). Although the point estimates of relative risk were very similar, benefit derived from professional support achieved statistical significance for any breastfeeding (RR 0.89 [0.81, 0.97]; 10 trials, 19 696 women) but not for exclusive breastfeeding (RR 0.90 [0.81, 1.01]; six trials, 18 258 women). Lay support was effective in reducing the cessation of exclusive breastfeeding (RR 0.66 [0.49, 0.89]; five trials, 2530 women) while the strength of its effect on any breastfeeding was less clear (RR 0.84 [0.69, 1.02]; five trials, 2224 women). Professional support in the largest trial to assess health outcomes produced a significant reduction in the risk of gastrointestinal infections and atopic eczema. In two trials with children suffering from diarrhoeal illness, extra support was highly effective in increasing short-term exclusive breastfeeding rates and reducing recurrence of diarrhoea. This review supports the conclusion that supplementary breastfeeding support should be provided as part of routine health service provision. There is clear evidence for the effectiveness of professional support on the duration of any breastfeeding although the strength of its effect on the rate of exclusive breastfeeding is uncertain. Lay support is effective in promoting exclusive breastfeeding although the strength of its effect on the duration of any breastfeeding is uncertain. Evidence supports the promotion of exclusive breastfeeding as central to the management of diarrhoeal illness in partially breast-fed infants.

Exploring Fathers’ Role in Breastfeeding Practices in the Urban and Semiurban Settings of Karachi, Pakistan

“…The most critical support system is the baby's father. Literature review also endorses that among the various supports, a "father's support" for breastfeeding is significant to promote exclusive and optimum breastfeeding practices (Bar-Yam & Darby, 1997;Kirkland & Fein, 2003;Li, Darling, Maurice, Barker, & Grummer-Strawn, 2005;Li, Fridinger, & Grummer-Strawn, 2002;Morisky et al, 2002;Ny, Plantin, Dejin-Karlsson, & Dykes, 2008;Sikorski, Renfrew, Pindoria, & Wade, 2003;Sullivan, Leathers, & Kelley, 2004).…”

A Controlled Trial of the Father's Role in Breastfeeding Promotion

“…2 Several strategies have been used to promote breastfeeding, such as setting standards for maternity services 3,4 (eg, the joint World Health Organization-United Nations Children's Fund [WHO-UNICEF] Baby Friendly Initiative), public education through media campaigns, and health professionals and peer-led initiatives to support individual mothers. [5][6][7][8][9] Support from the infant's father through active participation in the breastfeeding decision, together with a positive attitude and knowledge about the benefits of breastfeeding, has been shown to have a strong influence on the initiation and duration of breastfeeding in observational studies, 2,10 but scientific evidence is not available as to whether training fathers to manage the most common lactation difficulties can enhance breastfeeding rates. We conducted a controlled trial to test the hypothesis that teaching the fathers how to prevent and manage breastfeeding problems is associated with an increased duration of breastfeeding.…”

Impact of Educational Materials on the Duration of Exclusive Breastfeeding Assured by Women Who Delivered at the Souissi Maternity Hospital in Rabat

“…The strategy has been successful in extending the duration of EB, a result supported by a systematic review which has shown that non face-to-face support strategies are ineffective in promoting breastfeeding [27].…”